Ramblings of an Emergency Physician in Texas

Three cases of measles have been identified in Houston. Prior to diagnosis, but during the period of communicability, the infected individuals visited several health care facilities in the Houston area. The sites visited between Dec. 4 and Dec. 12 include: Texas Children’s Hospital, a doctors’ office at 2500 Tanglewilde, St. Luke’s Minor Emergency (San Felipe), Kelsey-Seybold Clinic (Holcombe), and a doctor’s office at Texas Medical Center.

The incubation period for measles is generally 14 days from exposure to rash, however it can range from 7 to 18 days. Measles is highly communicable with greater than 90% secondary attack rate among susceptible persons. When considering your practice policies in cases of rash illness, remember that transmission has been documented to occur in waiting room settings with exposures occurring up to 2 hours after the infectious patient’s visit. Cases may transmit virus from 4 days prior to 4 days following rash onset.

With measles occurring in the state, the diagnosis should be considered with any febrile rash illness. Please report upon suspicion any possible measles cases to your local or regional health department. Health departments will assist with specific testing and shipment of specimens.

Sincerely,

Col. W.S. “Chip” Riggins Jr., MD, MPH
Chair, Council on Public Health

The real story here is how a patient with the number one infectious disease in the world visited 5 different doctors (including a Childrens’ Hospital) and it wasn’t picked up. This story doesn’t say how it was finally diagnosed. Oh, and why this child hadn’t had their MMR, which is (usually) protective against said virus.